hypertension management in terms of routine agents

Conditions: Hypertension; Emergency Medicine

Summary: known hypertensive patients admitted to emergency department with increased blood pressure will be evaluated in terms of antihypertensive agents given at hospital, degree of blood pressure decrease, hospital stay and laboratory and imaging tests ordered. the impact of routine oral antihypertensive agents used by the patients on these parameter will be assessed.

hypertensive patients account for approximately 1-25% of annual emergency department visits . while this figure varies by region, hypertensive patients are among the groups that contribute significantly to emergency department crowding and workload . hypertensive emergencies constitute about 0.3-0.9% of all patients, and this number is rapidly increasing each year . the 2017 aha hypertension guidelines emphasize that severe elevations in blood pressure (hypertensive crisis and hypertensive urgency) do not require emergency department visits or referrals unless there is end-organ damage . it is noted that treatment in these patients typically involves dose adjustment or a change in medication . the 2023 esc hypertension guidelines recommend that in patients presenting to the emergency department with a hypertensive crisis, blood pressure should be gradually lowered with oral agents over a 24-48 hour period. these patients do not usually require hospital admission but can be monitored in an outpatient setting for clinical evaluation. it is noted that their blood pressure may remain elevated upon discharge from the emergency department, and follow-up in a clinic is necessary for reevaluation of chronic therapy . some studies have indicated that both oral and intravenous treatments are preferred for patients presenting with hypertensive crises, highlighting that the approach can vary from physician to physician . when evaluating literature reviews, published guidelines, and conducted studies, it is observed that there are differences between european and american approaches in defining and treating hypertensive crisis, as well as variability in physician management of these patients . in our study, we plan to evaluate the effect of emergency department treatment on lowering blood pressure in known hypertensive patients (≥140/80) without end-organ damage. additionally, we aim to assess the impact of the antihypertensive agents that patients routinely use on their length of stay in the emergency department, as well as the frequency and effectiveness of the medications used, and the target blood pressure values achieved post-treatment according to guidelines.

Eligibility criteria:
inclusion criteria: 1. patients aged 18 and older. 2. blood pressure measured at ≥140/80. 3. diagnosis of essential hypertension. exclusion criteria: 1. pregnant patients. 2. individuals without a prior diagnosis of hypertension. 3. patients with end-organ damage (hypertensive emergency). 4. patients whose routine antihypertensive agents are unavailable. 5. patients who leave the clinic without permission, making follow-up data inaccessible.

Keywords: hypertension emergency medicine oral antihypertensive agents